The Delaware Division of Public Health (DPH) has identified a case of vancomycin resistant Staphylococcus aureus (VRSA). The 83-year-old
patient with multiple co-morbidities is a resident of a long-term care facility in Delaware.

The VRSA isolated by the DPH Laboratory is susceptible to tetracycline and trimethoprim-sulfamethoxazole.

Staphylococcus aureus is an important cause of healthcare and community-associated infections. Diseases associated with this common
pathogen range from mild skin and soft tissue infections to potentially fatal systemic infections and affects individuals of all ages.
Previously uniformly susceptible to penicillin, widespread use of this antibiotic led to increased resistance and resultant reliance on
vancomycin for treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. The increased use of vancomycin has resulted
in a change of the susceptibility of Staphylococcus aureus to this antibiotic.

The possibility of VRSA should be considered in patients who present with skin infections, bloodstream infections, surgical wound
infections, and have history of underlying chronic conditions (such as chronic skin ulcers and diabetes), previous treatment with
vancomycin, and history of MRSA or vancomycin resistant enterococcus (VRE).

This Delaware case represents only the 12th confirmed case of VRSA reported in the U.S. DPH confirmed an additional case of VRSA in
early April 2010. The DPH Bureau of Epidemiology is investigating this case and possible contacts per CDC recommendation.

Transmission of VRSA

VRSA is potentially transmissible from person-to-person, but such transmission has not been documented. To date, all patients with
confirmed VRSA infections have had significant co-morbidities such as diabetes and renal disease, previous infections with MRSA, invasive
procedures and devices, recent hospitalizations and recent exposure to vancomycin and other antimicrobial agents.

Prevention and Control

Infection control guidelines and practices in healthcare facilities are well documented and include the prevention and control of
multidrug-resistant organisms including VRSA. Stringent handwashing, the use of barrier and contact precautions and appropriate
antibiotic use are the basis for controlling the spread of any infectious disease.

For More Information

DPH, Bureau of Epidemiology can be contacted at (302) 744-1033 or 1-888-295-5156.

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